Our Approach to Health Claims Negotiation

Our approach to health claims negotiation is simple; we negotiate each claim first, before settling on a PPO discount. We utilize our team of expert claims negotiators in securing deep discounts.

Our out-of-network claims savings solutions rely on Medicare reimbursement levels, usual & customary, code edits, bill review, and supplemental networks to achieve the best results in as little as three to five days. We achieve our results for you not based off of billed charges, but instead off of what Medicare typically reimburses for the services that were provided to the patient.

If we can’t secure a discount through our health claims negotiation, or if our data informs us that one of our other claims services will yield a better discount, the claim will be re-routed.

The Traditional Claims Flow

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Our approach is different as we negotiate first and most other companies just use a standard flow model for out-of-network claims. Typically their claims go through a Primary PPO network and any non-par claims flow through travel or wrap networks and then through an aggregator. Any claims that don’t hit these networks may then be flagged for negotiation.

The Consilium Solution

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Many travel and wrap networks and aggregators re-price claims through their own contracts and secure only minimal discounts. And many claims negotiation companies negotiate only off of already inflated billed charges, again yielding minimal savings to your bottom line.

Our results are achieved very quickly and we never have any balance billing to members.

Contact us today to see how our approach to health claims negotiation is different from the rest.


Consilium Decision Engine

Healthcare intelligence technology for optimal results

Features

Successful claims analysis and management